BNF for Children 2011-2012

BNFC 2011–2012 Prescribing in renal impairment 15ImportantThe information on dose adjustment in BNF forChildren is expressed in terms of estimated glomerularfiltration rate.Renal function in adults is increasingly beingreported as estimated glomerular filtration rate(eGFR) normalised to a body surface area of1.73 m 2 ; however, eGFR is derived from the MDRD(Modification of Diet in Renal Disease) formulawhich is not validated for use in children. eGFRderived from the MDRD formula should not beused to adjust drug doses in children with renalimpairment.In BNF for Children, values for measures of renalfunction are included where possible. However, wheresuch values are not available, the BNF for Childrenreflects the terms used in the published information.Chronic kidney disease in adults: UK guidelines foridentification, management and referral (March2006) defines renal function as follows:Degree of impairment eGFR 1 mL/minute/1.73 m 2Normal: Stage 1More than 90 (with otherevidence of kidney damage)Mild: Stage 260–89 (with other evidenceof kidney damage)Moderate 2 : Stage 3 30–59Severe: Stage 4 15–29Established renal failure: Less than 15Stage 51. Estimated glomerular filtration rate (eGFR) derived fromthe Modification of Diet in Renal Disease (MDRD) formulafor use in patients over 18 years2. NICE clinical guideline 73 (September 2008)—Chronickidney disease: Stage 3A eGFR = 45–59, Stage 3B eGFR =30–44Prescribing in renal impairmentDialysisFor prescribing in children on renal replacementtherapy consult specialist literature.Drug prescribing should be kept to the minimum in allchildren with severe renal disease.If even mild renal impairment is considered likely onclinical grounds, renal function should be checkedbefore prescribing any drug which requires dose modification.Where care is needed when prescribing in renal impairment,this is indicated under the relevant drug in BNFfor Children.